Autognosis rounds for medical house staff.

The authors describe the autognosis countertransference rounds for medical house staff at the Massachusetts General Hospital. At these rounds, which have been held weekly for more than a decade in the intensive care unit, countertransference phenomena and their relationship to medical practice are discussed. Methods that have facilitated the autognostic process are provided and highlighted by brief case examples. Participants at these rounds report that their self-awareness increases and the clinical care they provide often improves.

Nephrotic syndrome associated with Kimura's disease.

Kimura's disease consists of lesions that appear as single or multiple red-brown papules or as subcutaneous nodules with a predilection for the head and neck region. Although it principally affects the skin and soft tissues, there is a high prevalence of associated renal disease. We report a case of nephrotic syndrome associated with Kimura's disease. Our patient is distinctive in that his disease first manifested while residing in the Western hemisphere; the renal disease was characterized as mesangial proliferative glomerulonephritis with renal impairment, and his nephrotic syndrome remitted with standard doses of prednisone.

Energetic cost of carrying loads: have African women discovered an economic way?

When travelling in East Africa one is often surprised at the prodigious loads carried by the women of the area. It is not uncommon to see women of the Luo tribe carrying loads equivalent to 70% of their body mass balanced on the top of their heads (Fig. 1). Women of the Kikuyu tribe carry equally large loads supported by a strap across their foreheads; this frequently results in a permanently grooved skull. Recent experiments on running horses, humans, dogs and rats showed that the energy expended in carrying a load increased in direct proportion to the weight of the load for each animal at each speed, that is, carrying a load equal to 20% of body weight increased the rate of energy consumption by 20% (ref. 1). The purpose of the present study was to determine whether these African women use specialized mechanisms for carrying very large loads cheaply. We found that both the Luo and Kikuyu women could carry loads of up to 20% of their body weight without increasing their rate of energy consumption. For heavier loads there was a proportional increase in energy consumption, that is, a 30% load increased energy consumption by 10%, a 40% load by 20% and so on. We suggest that some element of training and/or anatomical change since childhood may allow these women to carry heavy loads economically.